Key points Estimates of fecal incontinence range from 11% to 20% of community-dwelling women older than 64 years. More than 30% of women reporting urinary incontinence also report fecal incontinence, known as dual incontinence. The internal anal sphincter, under autonomic…
Key points Continence is determined by the balance between forces that maintain urethral closure and those that affect detrusor function. Parasympathetic nervous system activity via the neurotransmitter acetylcholine stimulates receptors in the bladder wall to activate detrusor contraction. Sympathetic nervous…
Key points Pelvic organ prolapse is defined as the descent of one or more compartments of the vagina: the anterior vaginal wall, posterior vaginal wall, uterus (cervix), or apex (vaginal vault or cuff scar after hysterectomy). Pelvic organ prolapse often…
Key points Endometriosis is a benign, usually progressive, and sometimes recurrent disease that invades locally and disseminates widely. Causes include retrograde menstruation, coelomic metaplasia, vascular metastasis, immunologic changes, iatrogenic dissemination, and a genetic predisposition. Endometriosis lesions produce estrogen locally and…
Key points The most common large cyst of the vulva is a cystic dilation of an obstructed Bartholin duct, with a lifetime risk estimated to be 2%. These cysts occur most often during the third decade. Inflamed cysts may be…
Key points The rate of ectopic pregnancy in the United States has remained fairly constant since the early 2000s and is approximately 6.6 in 1000 pregnancies in women aged 15 to 24. Risks of ectopic pregnancy include age, smoking, pelvic…
Key points Pregnancy loss affects approximately 10% to 30% of all clinically recognized pregnancies, with nearly 80% occurring in the first trimester. The majority of pregnancy losses are sporadic and result from genetic causes that are greatly influenced by maternal…
Key points The breast consists of approximately 20% glandular tissue and 80% fat and connective tissue; increasing proportions of fibroglandular to fatty tissues are the mark of denser breasts. Breast density is associated with increased risks of malignancy. Lymph drainage…
Key points The average age of menopause in the United States is 51.3 years; it is younger in certain ethnic groups, and is genetically predetermined and is not related to the number of ovulations, race, socioeconomic conditions, education, height, weight,…
Key points Approximately 45% of all pregnancies in the United States are unintended, and among women who experience unintended pregnancy, more than half are not using contraception. By age 45, at least half of U.S. women will experience an unintended…